Obamacare fight fades with abortion dominating the health care debate in the presidential race
Abortion has replaced Obamacare as the top health care issue in the presidential campaign, underscoring the fallout from former President Donald Trump's failure to replace the Democrats' signature health law and success in canceling out Roe v. Wade.
Vice President Kamala Harris, the Democratic nominee, solidified Obamacare's place in American society with President Biden but struggled to backfill the nationwide abortion rights zeroed out in a 2022 Supreme Court ruling.
The result is a presidential cycle in which state limits on abortion, in vitro fertilization and other reproductive matters form the backbone of campaign debates over health care instead of bread-and-butter topics of old, such as insurance rates and drug prices.
"It is surprising that health care is not getting more attention this year because that always has been a great issue for Democrats. In the past, they have used that topic to their advantage and argued they were better at providing access than Republicans," said Darrell West, director of governance studies at the Brookings Institution. "This year, health care has been crowded out by the issues voters say they are worried about, which are immigration, crime, and reproductive rights."
Mr. Trump wants states to choose whether to limit abortion and proposed having the federal government pay for IVF treatments, saying it is a great option for growing families who need it.
He also said he would veto any federal abortion ban if Congress sent him such a bill.
Ms. Harris has spent the last two years characterizing abortion as a "fundamental freedom" that was taken away by Mr. Trump through his hand-picked justices. She's vowed to sign a bill that guarantees a nationwide right to abortion, seeing it as a political winner even as the GOP accuses the Democratic ticket of opening the floodgates to abortion on demand for all nine months of pregnancy.
She accuses Mr. Trump of being a political contortionist on the abortion topic who might not block a national ban or conservative efforts to curtail the distribution of common abortion pills.
The abortion fight eclipsed issues such as Obamacare, which dominated the 2012 and 2016 election cycles. However, a recent Gallup poll found two-thirds of Americans think health care is not getting enough attention from the presidential candidates. Only 6% said it is getting enough attention, and 27% said it is getting the right amount.
In a statement, the Trump campaign characterized his health care plans as intertwined with other top issues.
" Kamala Harris supports a Socialist healthcare monopoly that would ban private health insurance for 150 million Americans, and is now forcing hardworking, tax-paying, struggling Americans to pay for the housing, welfare, and now the health care of illegal immigrants," Trump campaign spokesman Karoline Leavitt said, referring to Ms. Harris's past support for single-payer health care. "President Trump will seal the border, stop the invasion and ensure that our health care system puts American citizens first."
Other health topics haven't gotten the same play as abortion or Obamacare, yet actions on any of them by a Harris or Trump administration would impact millions.
• Medicaid
The federal-state insurance program for the poor hasn't been a main talking point on the campaign trail. However, another Trump administration could revive state efforts to put work requirements on persons who receive the benefits.
The prior Trump administration allowed states to impose those requirements for the first time, through state waivers, but the Biden administration withdrew the waivers.
A Harris administration would further entrench Obamacare, so the handful of states that refused to broaden Medicaid eligibility under the health law might reconsider and accept federal funds to expand their rolls.
• Drug prices
Ms. Harris says she wants to extend a $35-per-month cap on out-of-pocket insulin costs, which seniors now enjoy, to all Americans. She also wants to implement and accelerate the Biden -era program that allowed Medicare to negotiate down an expanding list of drugs under the program for seniors.
Mr. Trump would expand on positions he took in his first term. As president, he gave people the "right to try" experimental drugs and developed a COVID-19 vaccine in record time, though he said he would oppose vaccine mandates. He is also likely to focus on programs that ensure American consumers get fair prices for drugs compared to other nations.
• New ideas
Mr. Trump is proposing a novel idea for health care: a "Presidential Commission of Independent Minds" to examine rising rates of chronic illnesses in children.
"We've seen a stunning rise in autism, auto-immune disorders, obesity, infertility, serious allergies and respiratory challenges. It is time to ask: What is going on?" Mr. Trump said in a video proposing the commission in June. "Is it the food that they eat? The environment that we live in? The over-prescription of certain medications? Is it the toxins and chemicals that are present in our homes?"
Ms. Harris is highlighting her efforts to cancel medical debt and erase it from credit reports.
"As president, she'll work with states to cancel medical debt for even more Americans," her website says.
Most of the health conversations, however, have circled back to Obamacare and abortion.
The Harris campaign wants Obamacare back in the conversation because it has been a political winner for Democrats since the GOP tried and failed to repeal and replace the law in 2017.
Roughly 21 million selected a plan on the Obamacare marketplace for the 2024 plan year, signaling a steady customer base despite early stumbles in attracting enrollees when the program launched under President Obama.
Mr. Trump says he would like to revisit Obamacare and find ways to improve it. But he faced criticism for saying at the Sept. 10 presidential debate that he had only "concepts of a plan."
"I'm not president right now," Mr. Trump said in the debate. "I would only change it if we come up with something better and less expensive. And there are concepts and options we have to do that. And you'll be hearing about it in the not-too-distant future."
His GOP running mate, Sen. J.D. Vance of Ohio, tried to fill in the lines, telling NBC News it is best to "not have a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pools."
That's likely a reference to high-risk pools, in which persons with medical conditions are subsidized apart from others so the healthier population doesn't see its premiums rise. Republicans floated the idea during the failed 2017 bid to replace Obamacare.
Mr. Vance, during the vice presidential debate, also said states should have the flexibility to experiment with "reinsurance," which funnels funds to insurers that enroll a large amount of high-cost enrollees. The idea is to absorb the costs insurers see from those sicker patients so they don't end up charging higher premiums to healthy people in the customer pool.
"It's clear the discussion has shifted in the campaign from ACA 'repeal' to 'reforms to the ACA' or 'changes or improvements to the ACA,'" said Rakesh Singh, the vice president for health policy initiatives at KFF, a nonprofit health policy research, polling and news organization. "I think what Republican voters who are supporting Donald Trump tell us from the surveys is that health care costs are on their minds, generally — not necessarily the ACA."
A Trump administration might be eager to change aspects of Obamacare promotion, such as advertising and enrollment assistance, and it might look askance at any extension of super-sized Obamacare subsidies that Mr. Biden and Democratic allies authorized in 2021 and extended in 2022.
The enhanced subsidies expire in 2025, so a Harris administration would be eager to extend them permanently to keep Obamacare popular. Decisions on the subsidies will coincide with the expiration of provisions in Mr. Trump's 2017 tax cuts, making it a big focus for Congress alongside whoever occupies the White House.
"Vice President Harris is fighting to improve health care and lower costs, and part of her plan includes making permanent credits that are lowering health care premiums by an average of about $800 a year for millions of Americans," Harris campaign spokesman Joseph Costello said. "But Donald Trump and congressional Republicans are hellbent on terminating the Affordable Care Act. They will try to gut health care however they can, because in the eyes of Donald Trump , ripping away protections for preexisting conditions and driving up the cost of coverage for working families will juice his billionaire handouts and corporate profits."
Meanwhile, Mr. Vance, serving as a policy sidekick for Mr. Trump on the campaign, is trying to reset the GOP's approach to abortion.
During a debate with Ms. Harris' running mate, Minnesota Gov. Tim Walz, the senator said the GOP needed to reframe the debate to regain voters' trust.
"I want us to support fertility treatments. I want us to make it easier for moms to afford to have babies. I want it to make it easier for young families to afford a home so they can afford a place to raise that family," Mr. Vance said. "And I think there's so much that we can do on the public policy front just to give women more options."
Mr. Walz said his GOP opponent cannot be trusted and said a woman's right to an abortion shouldn't be dictated by geography.
